534634

research-article2014

RPSXXX10.1177/1540796914534634Research and Practice for Persons with Severe DisabilitiesHudson and Browder

Article

Improving Listening Comprehension

Responses for Students With
Moderate Intellectual Disability
During Literacy Class

Research and Practice for Persons

with Severe Disabilities
2014, Vol. 39(1) 1129
The Author(s) 2014
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DOI: 10.1177/1540796914534634
rpsd.sagepub.com

Melissa E. Hudson1 and Diane M. Browder2

Abstract
This study evaluated the effects of a peer-delivered least prompts intervention and adapted read-alouds
of a grade-level novel on correct listening comprehension responses for participants with moderate
intellectual disability. Before the study began, participants were taught concepts for wh- words (i.e., who,
what, why, when, and where), to request help, and to self-monitor correct responses in the special
education classroom. Then, fifth-grade peer tutors without disabilities (peer tutors) provided opportunities
for participants to apply these skills during literacy class using a system of least prompts intervention and
read-alouds of an adapted novel being read by students without disabilities in the class. The least prompts
intervention included wh- word rules and opportunities to hear text again. After the intervention, all
participants increased the number of unmodeled prompted correct responses and one participant learned
to make independent unprompted correct responses after the text was read initially. In addition, two
participants learned to respond correctly when questions were asked by the general education teacher
during literacy class.
Keywords
listening comprehension, students with moderate intellectual disability, read-alouds, adapted grade-level
text, peer tutors, system of least prompts

Providing meaningful academic instruction for students with moderate and severe disabilities in general
education settings is challenging. There are few models to guide practice and many questions: What content
should be taught? Who will teach the content? If students are also receiving special education instruction,
how can skills learned in special education be generalized to general education settings? In an article about
effective instructional practices in general education settings for these students, Copeland and Cosbey
(2008-2009) recommended using existing general education practices as well as evidence-based practices
associated with special education settings; however, there is little research on this topic. In a recent review
of the literature, Hudson, Browder, and Wood (2013) identified only 17 studies that focused on academic
learning for students with moderate and severe intellectual disability in general education. Results from this
research indicate that students can learn academic content linked to the general curriculum delivered by
people available in general education (i.e., teachers, paraprofessionals, students without disabilities), but
1American
2University

Institutes for Research, USA

of North Carolina at Charlotte, USA

Corresponding Author:
Melissa E. Hudson, American Institutes for Research, 1000 Thomas Jefferson Street NW, Washington, DC, 20007, USA.
Email: mhudson@air.org

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Research and Practice for Persons with Severe Disabilities 39(1)

while most of the studies taught academic skills linked to the core content, the content was often limited to
vocabulary words and definitions. To be successful in general education, students need to learn a variety of
content, including concepts, multistep processes, and comprehension (Browder, Hudson, & Wood, 2014).
Comprehension of text is especially important for students because most learning depends on it; however, many students with moderate and severe intellectual disability are either emergent readers or nonreaders (Towles-Reeves, Kearns, Kleinert, & Kleinert, 2009) who depend on mature readers or technology to
read text for them. For these students, listening comprehension (the ability to make meaning from spoken
communication or text read-aloud; Browder et al., 2009) becomes the goal of instruction.
One strategy that has been used to improve correct listening comprehension responses for students in
special education classrooms is read-alouds and the system of least prompts (Hudson, Browder, & Wakeman,
2013). For example, Mims, Browder, Baker, Lee, and Spooner (2009) used read-alouds of adapted fictional
stories (e.g., Alexander and the Terrible, Horrible, No Good Very Bad Day; Viorst, 1972) and the system of
least prompts to improve listening comprehension responses for students with severe intellectual disability
who had visual impairments. Objects representing selected nouns from the text were affixed to the pages of
picture books (e.g., a package of gum for the gum Alexander got stuck in his hair). Students read along by
touching the objects on the page and used the same objects to answer literal recall questions (e.g., What did
Alexander get stuck in his hairgum or a toothbrush?)
Building on this research, Mims, Hudson, and Browder (2012) used read-alouds of adapted sixth-grade
biographies and the system of least prompts to increase correct listening comprehension responses for four
middle school students with severe developmental disabilities. The prompts used in this study were modified from typical responses in the system of least prompts (e.g., verbal, model, physical) to focus on increasingly narrower selections of text. For example, in the first prompt, the paragraph containing the information
needed to answer correctly was reread and, in the second prompt, the sentence containing the information
needed to answer correctly was reread. In addition, in the first prompt, students were given a wh- question
rule (e.g., When you hear who, listen for a person.). The adapted biographies were based on originals but
reduced in complexity and length. Important words were paired with picture symbols and definitions and
explanations were added. During the read-aloud, students used a graphic organizer to organize information
(i.e., what happened first, next, last). All students increased correct responding across five biographies and
three students increased the number of correct responses to questions from new biographies.
In the first application in a general education context, Hudson, Browder, and Jimenez (2014) focused on
increasing correct listening comprehension responses for three elementary students with moderate intellectual disability in a fourth-grade general education class. In this study, peer tutors used a script to deliver
the system of least prompts intervention and read-alouds of adapted science content during literacy workshop when other students were involved in independent learning activities. Like the Mims et al. (2012)
study, the first two prompts gave students an opportunity to hear selected text again. In the third prompt, the
interventionist said the correct answer and, in the fourth prompt, said and pointed to the correct response on
a six-option response board. For each science lesson, the same science content peers without disabilities
were learning was summarized into a read-aloud, definitions and explanations were added, and a small
picture was placed at the beginning of the lesson that illustrated the main idea of the lesson. Unlike the
Mims et al. (2012) study, students were not given rules for answering wh- questions or a graphic organizer.
While students increased the number of correct comprehension responses after intervention, only one student demonstrated generalization of skills to new science content. In addition, no generalization measures
were conducted in the general education science class because students received instruction at a different
time than science class, so it is not known if comprehension skills gained during intervention generalized to
the general education science class.
Assessing listening comprehension differs from reading comprehension in that it is most often done
orally. While listening comprehension can be assessed in different ways (e.g., retelling a story), answering
oral questions is a common way for students with disabilities to demonstrate their understanding of text
read-aloud (Morgan, Moni, & Jobling, 2009; Reis, 1986). Because of this, it is important that students
understand what comprehension questions are asking (e.g., a who question asks about a person). In an
action research study, Morgan et al. (2009) taught the concepts of wh- words to young adults with Down
syndrome before wh- word questions were asked. In this way, when the participants answered a question

Hudson and Browder

13

incorrectly, it was more likely that the incorrect response was due to a lack of comprehension and not
because the participants did not understand what the question was asking.
To summarize, only one study in the literature has focused on improving listening comprehension
responses for students with intellectual disability in a general education setting (Hudson et al., 2014). Also,
few models exist that demonstrate how skills taught in special education can be generalized to academic
instruction in the general education classroom. In addition, while research suggests that teaching rules (e.g.,
wh- question rules) in the system of least prompts (Mims et al., 2012) and teaching wh- word concepts
before instruction (Morgan et al., 2009) may contribute to improved acquisition and generalization of skills,
these findings need to be replicated. Therefore, the purpose of this study was to evaluate the effects of a
peer-delivered least prompts intervention and grade-level read-alouds on listening comprehension for three
students with moderate intellectual disability in a fifth-grade literacy class. Specific research questions
guiding the study were as follows:
Research Question 1: What was the effect of the intervention on unmodeled, text-only responses (i.e.,
Prompted Correct [PC])?
Research Question 2: What was the effect of the intervention on independent unprompted correct
responses after the first reading (i.e., Independent Correct [IC])?
Research Question 3: Did listening comprehension skills acquired during instruction generalize to the
general education literacy class when the intervention was delivered by the general education teacher
(i.e., Generalized Correct [GC])?

Method
Participants
Participants with disabilities. The participates without disabilities (participants) in this study were three elementary students, aged 9 to 11 years, who attended one of two self-contained special education classes for
students with intellectual disability located in a public elementary school in a large, urban school district in
the southeastern United States. All participants (a) were recommended by their special education teacher,
(b) communicated using picture symbols or spoken language, (c) met eligibility requirements under the
category of intellectual disability, (d) had an intelligence quotient (IQ) of 55 or less, (e) attended school
regularly, (f) had normal hearing and vision with corrections (e.g., hearing aids, eye glasses), and (g) had
signed parental informed consent. In addition, all participants expressed choices through spoken language,
eye gaze, pointing, and/or by activating a switch; selected discriminatively from an array of nine options;
and followed verbal directions. Students with a history of significant problem behavior were excluded from
the study. Pseudonyms are used for the actual names of participants (Verla, Robert, and Mason).
Verla was a 10-year-old Hispanic female with moderate intellectual disability and severe physical disabilities. Verla was nonverbal and used a combination of alternative and augmentative communication
devices, including a DynaVox, yes/no words located on the arms of her wheelchair, and a communication
book of picture symbols. Verla used a wheelchair to get around school on her own with the exception of a
couple of steep ramps. Verla recognized some sight words and letter sounds, but not letter blends and
struggled to read unfamiliar words. Verlas special education teacher reported that she had excellent receptive listening skills and could follow multiple step directions. Verla had participated in informal read-alouds
in the special education classroom where she answered questions requiring literal recall of information, but
had no experience with peer-delivered read-alouds in a general education classroom.
Robert was a 9-year-old Caucasian male with moderate intellectual disability (i.e., IQ of 51) and Williams
syndrome. Robert used verbal English to communicate and his language skills were strong, but his reading
and mathematics skills lagged behind. He could identify letters of the alphabet and a few sight words.
Roberts special education teacher reported that he attended to text read aloud for short periods of time, but
needed verbal cues to remain on-task. Robert had participated in informal read-alouds in the special education classroom and had some experience with peer buddies who provided social support in special classes
(e.g., music, art) but no experience with peer-delivered read-alouds in a general education classroom.

14

Research and Practice for Persons with Severe Disabilities 39(1)

Mason was an 11-year-old Hispanic male with moderate intellectual disability (i.e., IQ of 51) and Down
syndrome. Mason used verbal English to communicate, but his speech was often unintelligible due to poor
articulation and soft-spoken words. He could recognize some sight words and, with help from the special
education classroom teacher, could apply some decoding skills to sound out unfamiliar words. Masons
special education teacher reported that he had good receptive listening skills and followed multiple step
directions. Mason also had experience in informal read-alouds in the special education classroom, but no
experience with peer-delivered read-alouds in a general education literacy class.
Peer tutors and peer participants. Five peer tutors were selected from fifth graders without disabilities in a
general education literacy class in the same elementary school as participants. All peer tutors demonstrated
a desire to be a peer tutor, attended school regularly, had a passing grade in reading at the time of the study,
had signed parental informed consent and signed student assent, and demonstrated competency in delivering the least prompts intervention and reading prosody. The three peer tutors who delivered the intervention
to participants selected their own pseudonyms (Michael, Rocky, and Brittany).
Michael was a 10-year-old Hispanic male who read above grade level and played on the schools football
team. He had no previous experience as a peer tutor and was recommended for peer tutoring by the general
education teacher because he was an excellent student and extremely patient and helpful. Michael delivered
the intervention to Verla. Rocky was a 10-year-old African American female. Rocky was on grade level in
reading and had no previous experience as a peer tutor, but had become interested in peer tutoring after
observing the peer tutors working with students with disabilities in her fourth-grade class. Rocky delivered
the intervention to Robert. Brittany was an 11-year-old Hispanic female who was above grade level in reading. Brittany had participated as a peer tutor in a study conducted by the researcher in fourth grade. Brittany
delivered the intervention to Mason. Two other peer tutors read generalization chapters to participants during the generalization sessions. All other students in the fifth-grade literacy class were invited to participate
in the study as peer participants by completing a presurvey and a postsurvey regarding their attitudes about
students with disabilities attending their school.
General and special education teachers. The fifth-grade general education teacher had a bachelors degree in
elementary education (K-6) and 9 years of teaching experience. He collaborated with the researcher about
the literacy content, nominated students for peer tutoring, communicated with students parents about the
purpose of the study, facilitated the acquisition of parental informed consent and student assent, included
participants with moderate intellectual disability during literacy class, administered the presurvey and postsurvey, and completed a social validity form. Two special education teachers of students with mild, moderate, and severe intellectual disability participated in the study. One teacher held a masters of arts in teaching
(MAT) in special education and had 6 years of special education teaching experience. The other teacher had
a bachelors degree, 3 years of teaching experience, and was one course away from completing a MAT
special education certification. Special education teachers nominated participants, communicated with parents, facilitated the acquisition of parental informed consent, and completed social validity forms.

Settings
General education classroom. Peer tutors delivered the least prompts intervention during literacy class from
9:15 a.m. to 10:30 a.m. The class was attended by 35 fifth graders and students sat in groups of 4 or 5. The
general education teacher delivered group instruction and facilitated small group work at tables and learning centers. Participants with disabilities sat with peer tutors and participated in small group activities when
they were not involved in peer-delivered intervention or generalization probe sessions. Individual peerdelivered instruction occurred at one of the round tables in the room and generalization probe sessions
occurred in a silent reading area.
Baseline and ongoing probe sessions. Individual baseline and ongoing probe sessions were conducted by the
researcher (first author) in a special education classroom for students with intellectual disability. Twelve

15

Hudson and Browder

Table 1. Wh- Word Question Template.
Question
Who [verb] [character] [action from the story]?
Where do/did [character] [verb]?
When do/did [event] take place?
What do/did [character] [verb]?
Why do/did [action from the story]?
Why do/did [action from the story]?

Example question from novel

Who sent Byron to the store?
Where do the Watsons live?
When did Byron help Kenny?
What did Kenny find?
Why did people rush to the church?
Why did Byron stop talking?

other students with intellectual disability received daily instruction in the special education classrooms for
students with intellectual disabilities at the school.
Peer tutor training. The researcher conducted a group introductory training in the school library and individual training sessions at a table in the foyer outside the cafeteria. This area provided space for peer tutors
to practice using the intervention materials and was generally quiet during the time planned for the intervention (i.e., second block).

Materials
Grade-level book. The 15 chapters of The Watsons Go to Birmingham1963 (Curtis, 1995) were adapted for
the intervention because it was one of the novels being read by general education fifth graders in the literacy
class when the study was implemented. Chapters 1 through 5 were used for baseline probe sessions and
peer-delivered intervention. Five of the remaining chapters were used during generalization probe sessions
(i.e., chapters 6-10).
Adapted text. The novel was adapted for use as a read-aloud using the procedures described by Browder,
Trela, and Jimenez (2007). Text summaries captured the main idea of each chapter and definitions and
explanations for important vocabulary words were added. Text summaries were rewritten at a two to three
grade comprehension level using the Lexile Analyzer (a free tool available at http://lexile.com/analyzer/).
The mean Lexile score for the adapted chapters was 570L (range = 530L-600L).
Listening comprehension questions. Inferential and factual recall comprehension questions were created using
a six-question template (see Table 1). For each intervention chapter (i.e., Chapters 1-5), 18 questions were
created that included three sets of six questions for each chapter. A different set of questions was asked in
each session so that no question was repeated during the intervention to prevent memorization of answers.
Likewise, three questions were created for each generalization chapter (i.e., Chapters 6-15), so that no question was repeated during generalization probe sessions.
Peer tutor scripts. A total of 15 peer tutor scripts were created, one script for each set of comprehension questions for the intervention chapters (Figure 1 contains an example of one page from a peer tutor script). Peer
tutor scripts included say statements printed in bold text and do statements printed in regular text. For example, the say and do statements for introducing a lesson were, Say: Lets review some important words in
your story today. Show me [name each response option and the HELP prompt one at a time]. Each adapted
chapter was divided into six pages and one comprehension question was paired with each page (i.e., six pages
and six questions). The peer tutor scripts were organized into six sections, one section for each page of
adapted text and the comprehension question paired with it. For each section, the text from the adapted chapter appeared in a blue box, followed by the question, error correction procedure, and the least prompts hierarchy. The participants response determined what the peer tutor said and did next in the intervention. For

16

Research and Practice for Persons with Severe Disabilities 39(1)

Figure 1. Page 1 of a peer tutor script.

example, if the participant answered correctly, the peer tutor pointed to the self-monitoring sheet and said,
Youre right! Make an X on your self-monitoring sheet. Lets turn the page and keep reading. Each script
included 21 steps and was 31 pages long. Peer tutor scripts and other materials (e.g., self-monitoring sheets,
data sheets) were organized in three-ring binders by comprehension question using numbered tabs.
Participant books. Adapted chapters were printed in large font (i.e., 18-point Calibri type), inserted into page
protectors, and placed in three-ring binders for participantsone chapter per binder for intervention chapters and one large binder for generalization chapters. A small picture was placed at the beginning of each
chapter that illustrated the chapter.
Response boards. Response boards (Figure 2) were created for all chapters. Response boards contained nine
options and were organized in a three-ring binder by question type. For example, the who response board

Hudson and Browder

17

Figure 2. An example of a participant response board used to answer who comprehension questions.

Note. Participant response boards contained nine response options, a prompt for asking for help, and a rule for answering the whword question.

contained response options only for people found in the story and was located under the who tab in the
three-ring binder. When used during the intervention, each response board contained the correct response as
well as eight plausible, but incorrect distracters. Response options were created by pairing a word or phrase
with a picture symbol using Writing with Symbols software (Mayer-Johnson, 2000). In addition to the nine
response options, each response board also contained a help prompt and a wh- question rule.

18

Research and Practice for Persons with Severe Disabilities 39(1)

Self-monitoring sheet. Students self-monitored their correct responses by using a self-monitoring sheet that
consisted of six boxes arranged horizontally on an 8 11 inch paper. Participants made an x in a box
each time they answered correctly without help and, when all six boxes were full, received a studentselected prize (e.g., pencil, small toy).

Research Design
A multiple probe design across participants (Gast, 2010) was used to establish experimental control. A multiple probe design allowed for instruction to begin with one participant while periodic baseline sessions
were conducted with all other participants, decreasing the threat of learning through prolonged testing and
exposure to intervention materials. This design also allowed for data to be collected on generalization of
intervention effects to untrained chapters before they were used in intervention (i.e., ongoing probe sessions). Study phases included baseline, intervention, and generalization. Preteaching of wh- word concepts,
requesting help, and self-monitoring occurred with participants before baseline and, after participants met
the criteria set for preteaching, the baseline phase began.
During the baseline phase, a minimum of five data points were collected for each participant until performance data were low and stable or descending for both PC and IC responses. Once a stable baseline was
obtained for all participants, the decision of when to change levels within the design was based on PC
responses. One participant began intervention and other participants continued in baseline. A new participant entered intervention when a change in level or trend for PC responses was evident for the participant
receiving intervention. Just prior to entering intervention, three consecutive data points were collected on
the participant entering intervention and one probe data point was collected for participants continuing in
baseline. For the participant entering intervention, the upcoming chapter used next in the intervention was
used for the third baseline data point.
At least one probe point was collected for each participant every eight sessions. Participants entered the
intervention phase in a time-lagged manner until all participants had received intervention. Participant(s)
received intervention once a day, three days a week. A new untrained adapted chapter was used every three
sessions during intervention and the intervention condition contained multiple chapters of an adapted gradelevel text. Experimental control was demonstrated by a change in level or trend of correct listening comprehension responses from baseline condition to intervention conditions across participants.

Dependent Variable and Data Collection Procedures

Prompt hierarchy. Four prompts were used in the system of least prompts intervention. The first two prompts
were text-only unmodeled prompts in which selected text was reread. The first prompt included rereading the
paragraph of text containing the information needed to answer the question correctly. In the second prompt, the
sentence containing the information needed to answer the question correctly was reread. The third and fourth
prompts were modeled prompts in which the correct answer was revealed. In the third prompt, the correct
answer was said and in the fourth prompt, the correct answer was said and pointed to on the response board.
Dependent variables. The first and primary dependent variable, PC, was the number of correct unmodeled
responses after hearing selected text reread (i.e., first and second prompts). At each of these levels, the participant had an equal chance of being right or wrong as the prompt did not reveal the correct answer. While
two other prompt levels were used in the intervention (i.e., the third and fourth prompts were modeled
prompts in which the correct response was said or said and pointed to on the response board), only correct
responses after the first or second prompt were recorded as PC.
The secondary dependent variable, IC, was the number of correct unprompted responses after participants heard the question paired with the read-aloud. PC and IC responses were graphed on separate data
paths to observe changes in these dependent variables (see Figure 3). The third dependent variable, GC, was
the number of correct responses during literacy class when the general education teacher asked the questions (see Table 2).

19

Hudson and Browder

System of Least Prompts Package Intervention
Baseline

Ch. 1

Ch. 2 Ch. 3

Ch. 4 Ch. 5

6
5

Number of Prompted Correct and Independent Correct Listening Comprehension Responses

4
3
2
1

Verla

//

-1

6
5
4
3
2
1

Robert

//

-1

6
5
4
3
2
1

Mason

0
-1
0

//

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42

Number of sessions
Figure 3. The number of Prompted Correct and Independent Correct responses are graphed.

Note. Prompted Correct responses are correct responses after hearing text read again (i.e., Prompts 1 and/or 2) and are
represented on the graph by squares. Independent Correct responses are independent unprompted correct responses and are
represented on the graph as circles. Solid circles represent participant responses during peer-delivered instruction and open
circles represent participant responses during baseline and ongoing probe sessions. A 2-week break in instruction due to a holiday
break is indicated by 2 forward slashes.

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Research and Practice for Persons with Severe Disabilities 39(1)

Table 2. Number of Correct Participant Responses During Literacy Class.

Participant
Verla

Robert

Mason

aStudents

Generalization chaptera

Prompted correct responses

Independent correct responses

6
7
8
9
Total
6
7
8
9
10
Total
6
7
8
9
10
Total

0
1
2
2
5/12
0
1
3
0
1
5/15
0
0
0
1
1
2/15

0
2
1
1
4/12
1
0
0
2
1
4/15
0
0
0
0
0
0/15

answered three different listening comprehension questions each chapter, one question each session.

Social validity. Three social validity measures were collected. Changes in peers without disabilities (peers)
attitudes about students with disabilities in their school were evaluated before and after the study using a
survey instrument adapted from an attitudinal survey developed by Haring, Breen, Pitts-Conway, Wilson,
and Gaylord-Ross (1983). In addition, key individuals involved in the study completed a social validity
form or interview, and information regarding changes in the peer tutors reading grades during the time of
the study was obtained from the general education classroom teacher after the study was finished.
Data collection.Correct responses were scored in two ways. PC was recorded for correct unmodeled
responses after hearing selected text reread (i.e., first and second prompts) and IC was recorded for correct
unprompted responses after hearing the question paired with the read-aloud.

Procedures
Peer tutor training. Interested students from the fifth-grade literacy class attended the introductory group session where the purpose of the study and the system of least prompts intervention were described. Following
the group session, 12 students obtained parental informed consent and student assent. Five of these students
were selected by the general education classroom teacher to participate in the study. The other seven students
were taught to deliver read-alouds at a later date by the researcher and participated as peer tutors in a separate
read-aloud program implemented by the school. The peers and students with disabilities involved in the readaloud program did not include the peers and students with disabilities involved in this study.
The five students selected to participate in the study were given a peer tutor manual that contained a
sample script, a sample response board, and the self-monitoring sheet used in the study. Then, the students
were screened for reading prosody using an adaptation of the Multidimensional Fluency Scale (MFS;
Rasinski, 2003) and received individual training from the researcher. Together, the students practiced delivering the intervention using a script with the researcher. The researcher (playing the role of participant with
intellectual disability) provided a range of participant responses (i.e., responding correctly and incorrectly,
requesting help, failing to respond) so that peer tutors could practice delivering the full range of prompts in
the intervention. The researcher gave verbal feedback on students performance and modeled delivery of the

Hudson and Browder

21

script when necessary. On average, students received 75 min of individual training (usually delivered in
15-min sessions) over 2 weeks. Individual role-play sessions were used to assess procedural fidelity (i.e.,
no errors in procedural fidelity for two consecutive sessions). All five students met the criterion for procedural fidelity and participated in the study; three students delivered the intervention and two read the generalization chapters aloud during literacy class.
Preteaching wh- word concepts, requesting help, and self-monitoring.Before the study began, the researcher
taught the wh- word concepts to the participants with disabilities in individual sessions in the special education classroom. The five wh- word concepts taught were as follows: what tells about a thing, why tells about
a reason, when tells about a time or date, where tells about a place, and who tells about a person. The
researcher used examples and nonexamples instruction and the following steps to teach the concepts: (a)
presented five cards one at a time (three cards were examples of the concept being taught and two cards were
nonexamples) and, as each card was presented, said, This is a [concept] or This is not a [concept]; (b)
removed the cards and presented four additional cards at once (one card of the concept being taught and three
distracters) and asked participants to point to the [concept]; and (c) for correct responses, provided descriptive verbal feedback (e.g., Youre right. A desk is a thing.) or for incorrect responses, pointed to the correct
response and said, This is a thing. Wh- word concepts were taught in sequential order (i.e., who, when,
where, what, why) and participants met criteria for one wh- word concept before they received instruction on
the next. Criteria for mastery for each wh- word concept was 4/5 correct responses, two consecutive sessions.
With the exception of two concepts (i.e., why and when), SRA (McGraw-Hill) picture cards were used to
teach the concepts. Because adequate picture cards for the why and when concepts did not exist, the researcher
created cards using Writing With Symbols software (Mayer-Johnson, 2000) and blank 3 5 inch index cards.
Participants were also taught two nonacademic skills before the study began: to request help and selfmonitor correct responses. These skills were important for participants to be successful with the peerdelivered intervention in the general education setting. Participants were taught to ask for help verbally or
by pointing to the help prompt on the response board (see Figure 2 for a sample response board). During an
activity with the researcher, participants were asked to identify the contents of a wrapped package and were
given clues about what was inside the package when they asked for help. When the participant identified
what was inside the package, the package was theirs. The criterion for mastery was no more than one
prompt to ask for help a session for two consecutive sessions. Participants were also taught to self-monitor
IC responses during a read-aloud of a personalized story. Participants placed a check in one of six boxes on
the self-monitoring sheet each time they correctly answered questions about themselves or their families.
To evaluate if participants generalized asking for help during a read-aloud, participants were also asked
questions they were unlikely to know without help. Because peer tutors prompted participants to selfmonitor during intervention, no mastery criterion was needed.
General education teacher training. To teach the general education teacher how to deliver the system of least
prompts intervention, the researcher modeled the use of the least prompts intervention and provided feedback on the general educators implementation of the intervention until 90% of the steps were delivered
accurately. The teacher was given blank data sheets and an example of prompts for factual recall and inferential questions. Because the general education teacher did not use a script to deliver the intervention (like
the peer tutors), the text that needed to reread for the first and second prompts of the system of least prompts
were highlighted in different colors in the adapted chapters. Yellow brackets were placed around the paragraph containing the information needed to answer the question correctly (i.e., first prompt) and the sentence containing the information needed to answer the question correctly was underlined in green (i.e.,
second prompt). When a student asked for help, the general education teacher reread the text in yellow
brackets for the first prompt. If a second prompt was needed, the general education teacher reread the sentence underlined in green.
Baseline. A minimum of five baseline probe sessions were conducted with participants using the first five
adapted chapters of the novel. Chapters were selected randomly to avoid a sequence effect, but at least one

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Research and Practice for Persons with Severe Disabilities 39(1)

data point was collected for each chapter. Because there were three sets of comprehension questions developed for each chapter, participants used a game spinner to randomly select which set of comprehension questions was used. During baseline probe sessions, the researcher and participant sat side-by-side with the binder
of response boards, a self-monitoring sheet, and the adapted chapter on the table in front of them. The
researcher reviewed the vocabulary words for the chapter and taught unknown words as needed. Then the
researcher began reading the adapted chapter. At predetermined points in the chapter, the researcher stopped
reading, told participants the type of wh- word question that was going to be asked and directed participants
to turn to the appropriate response board (e.g., The first question is a who question. Turn to the who response
board.). When participants did not turn to the correct response board independently within 4 s, the researcher
turned to the correct board before continuing (this step was not scored). Then the researcher asked the listening comprehension question and waited 4 s for participants to answer. While the researcher did not ask participants if they wanted help, the response board they were taught to use to request help was available and,
when the participants asked for help, the researcher delivered the next prompt in least prompts hierarchy.
Responses were immediately recorded on a data sheet. The researcher continued reading the chapter and
asking questions until the chapter was read entirely and all comprehension questions were asked. Participants
were given verbal praise for general work behaviors and a small reward after each session. Baseline probe
sessions, intervention sessions, and ongoing probe sessions took 10 to 15 min to deliver.
Peer-delivered intervention.All peer-delivered intervention was provided in the general education literacy
class. The procedures for intervention sessions were the same as baseline sessions until a comprehension
question was asked. After asking a comprehension question, peer tutors asked participants if they were
ready to answer or if they wanted help. When participants asked for help, peer tutors delivered the next
prompt in the least prompts intervention. In the first prompt, three instructional scaffolds were given: the
type of wh- question (i.e., The first question is a who question.); a rule for the wh- question (e.g., When you
hear who, listen for a person.); and information about what to listen for when selected text was reread (i.e.,
Listen for who was hurt), and then the selected paragraph was reread. In the second prompt, the sentence
containing the answer was read again. In the third prompt, the correct answer was said. In the fourth (and
controlling) prompt, the correct answer was said and pointed to on the response board. Correct responses
were followed by descriptive verbal praise.
For incorrect responses, peer tutors pointed to the help prompt on the response board, reminded participants to ask for help when they did not know the answer, and then delivered the controlling prompt (i.e.,
said the correct response and pointed to the correct response on the response board). Following error correction, peer tutors turned to the next section of the script and continued. When participants did not initiate
a response within 4 s of the question (i.e., no response), peer tutors pointed to the help prompt and reminded
participants to ask for help; then delivered the next prompt in the system of least prompts. Both incorrect
responses and no response errors were scored as zero; however, incorrect responses resulted in peer tutors
delivering the controlling prompt and continuing the intervention, whereas when participants failed to
respond, they continued to have access to the system of least prompts intervention. This difference was
made to encourage participants to ask for help if they did not know the answer instead of guessing. When
participants had more than one error a session (regardless of the type of error), the researcher reviewed
procedures for requesting help with the student and peer tutor after the session.
Ongoing probe sessions. The researcher conducted the ongoing probe sessions in a special education classroom using the same procedure as baseline probe sessions to collect data. Ongoing probe sessions occurred
after three sessions of peer-delivered intervention and used the upcoming chapter next in the intervention.
Generalization probe sessions. The general education teacher conducted three generalization probe sessions
a week during literacy class. During generalization probe sessions, peer tutors read an adapted generalization chapter aloud at a naturally occurring time during the general education lesson and the general education teacher asked one predetermined comprehension question, delivered prompts as needed, and recorded
participants responses on a data collection sheet. Three different generalization questions were answered
each week (i.e., three per generalization chapter)one question after each generalization session.

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23

Procedural reliability. Procedural fidelity was collected a minimum of 30% of each study phase. A trained
second observer (doctoral student in special education) recorded the presence or absence of error during the
10-step intervention for the purpose of calculating procedural reliability. An error in any step of the procedure resulted in the step being scored as an error. Procedural fidelity was calculated by dividing number of
steps presented without error by the total number of steps delivered multiplied by 100 (Billingsley, White,
& Munson, 1980). Criterion for acceptability was no more than 1 step with error (i.e., 90%). If criterion fell
below 90%, the researcher met with the peer tutor (or if the interventionist was the lead researcher, a member of the research team met with the researcher) to review the intervention delivery to ensure the intervention was delivered consistently.
Interobserver agreement.Interobserver agreement (IOA) was collected on student responses by a trained
second observer a minimum of 30% of each study phase for each participant. Agreement data were computed
by comparing the responses for each trial point-by-point. An agreement was recorded if the responses were
the same and a disagreement was recorded if responses were different. Interobserver reliability data were
calculated by dividing the number of agreements by the number of agreements plus disagreements multiplied
by 100. Criterion for IOA on student responses was 90% or above. If IOA fell below 90%, the researcher met
with a member of the research team to discuss discrepancies in scoring student responses to provide consistency in scoring student responses. In addition, IOA was also collected on the procedural fidelity of the peerdelivered intervention sessions for a minimum of 30% of the sessions for each participant.

Data Analysis
Data for the first two dependent variables are summarized in Figure 3. The PC and IC graph was visually
inspected to identify changes in trend, level, and variability and to determine if a functional relationship
existed between the independent and dependent variables. The third dependent variable, GC, was correct
responses during literacy class when the comprehension question was asked by the general education
teacher. These data are summarized in Table 2.

Results
Reliability
Procedural fidelity data were collected for 32% of baseline probe sessions (i.e., 100%), 100% of peerdelivered intervention sessions (i.e., 98%; range = 97%-100%), and 33% of the generalization probe sessions during literacy class (i.e., 100%). IOA data for student responses were collected for 32% of baseline
probe sessions (i.e., 97%, range = 91.5%-100%), 32% of peer-delivered intervention sessions (i.e., 100%),
and 33% of the generalization probe sessions (i.e., 100%). IOA on procedural fidelity was collected for 33%
of the peer-delivered intervention sessions and was 99% (range = 98%-100%).

Student Data
Prompted Correct (PC) responses. The number of PC responses is displayed in Figure 3. All participants
improved their PC responses from baseline to intervention. During baseline, Verla averaged 0% PC
responses and during intervention, her PC responses increased to 15% (i.e., range = 0%-33%). During baseline, Robert averaged 0% PC responses and during intervention, his PC responses increased to 56% (i.e.,
range = 44%-72%). Likewise, during baseline, Mason averaged 0% PC responses and during intervention,
his PC responses increased to 48% (i.e., range = 0%-83%).
Independent Correct (IC) responses. The number of IC responses is also displayed in a separate data path in
Figure 3. Verla had a marked improvement in average IC responses from baseline to intervention. Verlas
average IC responses during baseline was 20% (i.e., range = 0%-33%) compared with 62% (i.e., range =
50%-67%) during intervention. Robert demonstrated a more modest increase in IC responses from baseline

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Research and Practice for Persons with Severe Disabilities 39(1)

to intervention. Roberts average IC responses during baseline was 6% (range = 0%-33%) compared with
17% (i.e., range = 6%-28%) during intervention. Masons IC responses from baseline to intervention
remained virtually unchanged. Masons average IC responses during baseline was 26% (i.e., range =
0%-33%) compared with 28% (i.e., range = 6%-44%) during intervention.
Generalized Correct (GC) responses. The number of GC responses for each student is displayed in Table 2.
Verla and Robert both had five PC responses and four IC responses during reading class. Mason, however,
had only two PC responses during reading class and no IC responses. The total number of questions asked
of participants during reading class varied from 12 to 15one question was asked each session. Due to
scheduling, Verla received 4 weeks of generalization probe sessions, whereas Robert and Mason each
received 5 weeks.

Social Validity
Social attitude survey. Twelve peers in the fifth-grade literacy class completed an attitude survey adapted
from Haring et al. (1983) before and after the intervention to measure changes in their attitude about students with disabilities in their school. Data from the presurvey indicated that most peers taking the survey
would interact with students with disabilities in ways that did not require much effort. For example, they
would talk to a student with special needs at school (i.e., n = 10); thought students with special needs should
be included in reading class (i.e., n = 10); and would say hi to a student with special needs (i.e., n = 11). In
contrast, fewer peers taking the presurvey indicated they would interact with students with special needs if
the interaction was more personal or required greater effort on their part. For example, five peers said they
would eat lunch with a student with special needs; seven said they liked having students with special needs
in their class; and eight said they would play with a student with special needs during recess. After the
study, peers indicated they were more willing to interact with students with disabilities at a deeper level.
Specifically, 10 peers indicated they liked having students with special needs in their class (an increase of
three); 10 peers would play with a student with special needs at recess (an increase of two); and eight peers
would eat lunch with a student with special needs (an increase of three).
Teacher social validity forms. The special and general education teachers strongly agreed to the following statements: (a) The peer-delivered intervention met the needs of the participants with disabilities; (b) The intervention did not take a lot of my time; (c) The intervention allowed students with moderate intellectual disability
to participate more fully in the general education class; (d) I would use this strategy with other students with
moderate intellectual disability; and (e) There were benefits for both the participants with disabilities and peer
tutors. In addition, the general education teacher strongly agreed with the statements (f) The intervention did
not disrupt the learning time of students without disabilities; (g) The strategy was efficient in promoting student learning; and (h) I would use this strategy with other students with moderate intellectual disability.
Peer tutor and participant social validity interviews. All peer tutors and participants indicated yes to the following statements: (a) I liked being a peer tutor/participant; (b) I would be a peer tutor/participant again; (c) I
would recommend being a peer tutor/participant to my friends; (d) I think it was important for me to be a peer
tutor/participant; and (e) I learned a lot being a peer tutor/participant. Finally, one participant agreed with the
statement that being a peer tutor was a lot of work while all the peer tutors and two participants disagreed.
Peer tutor grades. The general education teacher reported no changes in the reading grades for peer tutors
during the studys duration.

Discussion
The primary question asked in this research study was if a peer-delivered least prompts intervention and
adapted grade-level read-alouds improved Prompted Correct (PC) comprehension responses for

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25

participants. All participants PC responding was low and stable during baseline probe sessions, then
increased immediately after intervention for two participants and after the first chapter for the third participant (see Figure 3), indicating a functional relationship between the peer-delivered intervention and PC
responses.
The prompt hierarchy in this study differed from previous research in that the first two prompts did not
reveal the correct answer. Instead, selected text was reread (i.e., in the first prompt, the paragraph containing
the information needed to answer correctly was reread; in the second prompt, the sentence containing the
information needed to answer correctly was reread). In the Mims et al. (2009) and Mims et al. (2012) studies,
the least prompts hierarchy included modeled prompts in which the correct answer was said (i.e., verbal
prompt), said and shown (i.e., model prompt), or physically guided (i.e., physical prompt). While telling and
showing participants the correct responses promotes correct responding, it also makes it unclear if increases
in correct responding are due to improved listening comprehension skills or from imitating and complying
with the instructor. This study strengthened the read-aloud intervention by demonstrating how correct listening comprehension responses can be increased through the use of unmodeled text-only prompts.
This study also strengthened the inference that students were using the text to answer the questions
because none of the listening comprehension questions were repeated. In prior research (e.g., Hudson et al.,
2014; Mims et al., 2009), participants were asked the same listening comprehension questions multiple
times. Because participants were told the correct answers in the first session, correct responses during subsequent sessions could have been due to remembering the correct responses from the first session (i.e., a
memorized response). In this study, new questions were asked after each reading. Because participants were
not given the answers to the questions in previous readings, it is more likely that participants selected correct responses based on the text they heard and less likely they made a memorized response.
A second question asked in this study was if the peer-delivered least prompts intervention and adapted
grade-level read-alouds improved Independent Correct (IC) responses after the first reading of the text. It is
obvious that this is a high bar to achieve for students with moderate intellectual disabilities and the results
are mixed. For Verla, IC responses increased following intervention. In contrast, neither Roberts nor
Masons IC responses improved over baseline levels. These results demonstrate that Robert and Mason
learned to respond to the peer-assisted prompts and Verla learned to actually listen to the initial presentation
of the adapted text. Correctly answering questions about text after hearing it the first time is similar to
dependent variables used in read-aloud interventions with students with milder disabilities or students at
risk for disabilities (for a review of this literature, see Swanson et al., 2011); however, a better measure to
monitor progress for students with moderate and severe intellectual disability may be correct responding
after rereads that do not reveal the answer (the PC variable). Whether using technology or working with a
human reader, individuals with intellectual disability can learn to ask for text to be reread as needed. For
example, in this study, students asked for help verbally or used a help prompt on the response board to ask
for text to be reread.
This study also evaluated whether skills learned during intervention generalized to literacy class where
the generalization sessions were conducted by the general education teacher. For each generalization session, a peer tutor read a chapter of adapted text that was not used during intervention; then, the general
education teacher asked one question paired with the text and delivered the least prompts hierarchy as
needed. Like peer-delivered intervention, generalization chapters were used for three sessions before a new
chapter was introduced and a new comprehension question was asked each session, for a total of three comprehension questions for each generalization chapter. Verla and Robert answered five questions correctly
during reading class after asking for (and receiving) help from the general education teacher (i.e., PC) and
four questions correctly after the text was read with no additional help (i.e., IC). Mason, however, had only
two correct responses during literacy class, both after hearing text-only prompts from the teacher. His greatest gains were in making fewer errors as the sessions progressed. These data for Verla and Mason are consistent with their responding during intervention. In contrast, Roberts generalization results are impressive
and unexpected. While his IC responses did not improve above baseline levels during intervention, he
answered 27% of the generalization questions correctly after the text was read with no additional help.
Although responding varied, having the general education teacher call on these students to answer questions

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Research and Practice for Persons with Severe Disabilities 39(1)

about the novel the entire class was reading helped embed the students participation into the naturally
occurring class discussions.

Limitations
One limitation of this study is that the researchers presence was never faded due to the need to record participant response data during peer-delivered sessions. Peer tutors implemented the intervention with high
fidelity (i.e., M = 98%, range = 97%-100%), but the fidelity with which the peers would implement sessions
without adult supervision is unknown and remains an area for future research to evaluate.
A second limitation is that baseline and probe sessions were conducted by the researcher and the intervention sessions by peer tutors. Because different interventionists conducted these sessions, it cannot be
determined how much effect the presence of the peer or peer tutoring had on participants requests for help.
In the future, interventionists might want to train peer tutors to conduct the baseline probe sessions as well
as the intervention sessions.
A third limitation is that baseline data were not collected on participants responses to the general education teachers questions during literacy class. Without baseline data, it is not possible to rule out alternate
hypotheses for student learning during generalization probe sessions. For example, an alternative hypothesis is that students were able to learn from answers given by their peers without disabilities during the
ongoing lessons. Without baseline data to indicate the contrary, a causal relationship for the comprehension
responses cannot be inferred.
A fourth limitation is that only one strategy was used for assessing listening comprehension (i.e., orally
answering wh- word questions). The use of other listening comprehension strategies may have increased
correct responding for some participants. For example, Fletcher and Clayton (1994) used retelling a story
to improve listening comprehension. Perhaps using a different listening strategy would improve listening
comprehension for some students. This remains a question for future research.
A fifth limitation is the large amount of time needed to implement the intervention, including training the
peer tutors, writing the peer tutor scripts, and adapting the novel used in the intervention. It took approximately 75 min to train each peer tutor individually to deliver the intervention with fidelity. In addition, the
first author spent approximately 40 hr adapting the novel and another 40 hr writing the peer tutor scripts.
This time could be reduced by training peers in a group (instead of individually) and by using novels that
have already been adapted.
While the initial time investment is high, several outcomes are encouraging. First, once the peer tutors
were trained, they delivered the intervention with fidelity with very little support from the researcher. These
results are similar to other studies where researchers have used peer tutors (e.g., Jameson, McDonnell,
Polychronis, & Riesen, 2008; Jimenez, Browder, Spooner, & DiBiase, 2012). Once trained, peer tutors
could be used to implement other interventions in the general education classroom. Next, the use of scripts
could be faded for the peer tutors so that fewer scripts would be needed. The researcher in this study noted
anecdotally that the peer tutors relied less on the script as they conducted more sessions with participants in
the same way teachers rely less on scripted curriculum after they become comfortable using it. Furthermore,
the general education teacher delivered the system of least prompts without a script after a short session
with the researcher, using only colored highlights in the text to indicate what text should be reread for the
first and second prompts. Perhaps peer tutors could deliver the intervention without a script as well. Last,
an outcome that speaks to the overall efficacy of this intervention is that the intervention continued after the
study ended. The students with intellectual disabilities continued coming to literacy class and the only support needed by the general education teacher was another adapted grade-level novel.

Suggestions for Future Research

The participants in this study were all English language learners for whom English was their primary language. For students for whom English is not their primary language, one area for future research is to evaluate the effectiveness of this intervention for students with disabilities for whom English is a second language.

Hudson and Browder

27

In a recent study, Spooner, Rivera, Browder, Baker, and Salas (2009) found that the use of culturally contextual read-alouds delivered by a paraprofessional whose culture was similar to the students and the least
prompts intervention package improved the students emergent literacy skills. Peers without disabilities
who are fluent in another language or from a diverse culture could be paired with students with intellectual
disabilities who have similarly diverse backgrounds to teach listening comprehension skills in the general
education classroom.
Another area for future research is the need for more studies using a dependent variable like the one used
in this study. An issue of past research that has hindered the practice of shared story reading for teaching
listening comprehension for students with moderate and severe disabilities from becoming established as an
evidenced-based practice is that the dependent variable used in the shared story interventions have been
based on correct responses after modeled prompts and repeated comprehension questions. This study used
a dependent variable that included correct responses after unmodeled text-only prompts and nonrepeated
comprehension questions to measure gains in listening comprehension.

Implications for Practice

One implication for practice is that preteaching important academic and nonacademic skills (e.g., wh- word
concepts, requesting help, and self-monitoring) can help students with moderate intellectual disability be
successful with academic instruction in general education settings. In this study, participants were taught
five wh- word concepts (e.g., where tells about a place) in the special education classroom before the study
began to ensure they understood what the comprehension questions used in the intervention were asking. In
addition, students were taught to request help and self-monitor their correct responses, two nonacademic
skills that helped them be successful with the peer-delivered system of least prompts intervention in general
education. The peer-delivered intervention afforded opportunities to practice the skills gained in the special
education classroom using an adapted version of the novel everyone in the class was reading (i.e., The
Watsons Go to Birmingham1963).
A second implication for practice is that read-alouds of adapted grade-level literature and a least prompts
intervention can increase correct listening comprehension responses for students with moderate intellectual
disability in general education class. While read-alouds and the system of least prompts is a practice that has
been used to promote literacy in special education settings (for a review of this literature, see Hudson &
Test, 2011), its application in a general education context is virtually unevaluated. This is the second,
besides Hudson et al. (2014), to evaluate read-alouds of adapted grade-level literature and the system of
least prompts in a general education class setting. Hudson et al. adapted science content from the fourthgrade curriculum for the read-alouds. This study extends that work by adapting a novel from the fifth-grade
curriculum for the read-alouds. In addition, this study found results similar to Mims et al. (2012) in that two
of three participants had more correct responses with new chapters when the least prompts hierarchy
included a wh- question rule.
A final implication for practice is that peer tutoring is an effective way to teach academic content in
general education settings. These results are similar to those of other researchers who have used peer tutors
to teach academic content during ongoing activities in general education (e.g., Jameson et al., 2008; Jimenez
et al., 2012). Jameson et al. (2008) used peer tutors to teach key word definitions during health and art
classes and Jimenez et al. (2012) used peer tutors to vocabulary definitions and concepts during inquiry
science class. This study adds to that research by using peer tutors to increase correct listening comprehension responses during literacy class.

Summary
Providing effective instruction for students with moderate intellectual disability in general education settings is a challenging but important taskespecially in the area of listening comprehension because so
much of learning depends on good listening comprehension skills for these students. This study demonstrates how skills learned in the context of special education (i.e.., wh- word concepts, requesting help,

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Research and Practice for Persons with Severe Disabilities 39(1)

self-monitoring) can be used to improve listening comprehension responses in general education. Also
encouraging is that grade-level content can be adapted for use as a read-aloud and the least prompts hierarchy can be used to focus on the academic (vs. motoric) responses to be made. Finally, the use of peer tutors
to deliver instruction within the context of general education offers a solution for who will deliver instruction that may benefit both students with and without disabilities. Researchers are encouraged to replicate
and extend these procedures to create an evidence base for their use.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this
article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author Biographies
Melissa E. Hudson is an alternate assessment specialist for the American Institutes for Research in Washington, DC.
Her research interests include general curriculum access and alternate assessment for students with moderate and severe
disabilities.
Diane M. Browder is the Lake and Edward Snyder Distinguished Professor of Special Education at the University of
North Carolina at Charlotte. Her current research focuses on academic learning by students with moderate and severe
disabilities.

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